Transcatheter Tricuspid Valve Replacement Reduces Heart Failure Hospitalization: Insights from the Canadian Evoque Registry.

BACKGROUND: Severe tricuspid regurgitation (TR) causes high morbidity and recurrent heart failure hospitalizations (HFH). Transcatheter tricuspid valve replacement (TTVR) consistently eliminates TR, but real-world data on HFH reduction are limited. We therefore evaluated the impact of TTVR on HFH and clinical outcomes in a diverse cohort of compassionate-use and trial patients. METHODS: This prospective, multicenter Canadian registry included 75 high-risk patients (STS score 8.2±5.9%) undergoing TTVR with the EVOQUE system. The primary endpoint was a composite of all-cause death or heart failure hospitalization (HFH) within one year after TTVR. Secondary endpoints included the annualized HFH rate 12 months before vs after TTVR, symptoms, quality of life (KCCQ-Kansas City Cardiomyopathy Questionnaire), and functional capacity. RESULTS: Procedural success was high (technical: 97.3%; device: 93.3%), with sustained TR reduction to ≤mild (94.3%), and a 6.7% one-year mortality. TTVR resulted in an 76.1% relative reduction in HFH (p<0.001). NYHA Class III/IV decreased from 76% to 10% (p<0.001). Significant improvements were observed in six-minute walk distance (260.8±104.7m to 334.5±103.5m, p<0.001) and KCCQ score (56.2±15.2 to 73.5±19.2 points, p=0.001). Multivariable analysis identified baseline NYHA IV (OR 3.96, p=0.003) and prior HFH (OR 2.31, p=0.033) as independent predictors of the composite endpoint (HFH/death). Comparative analysis showed that while compassionate-use patients (n=24) had a higher-risk profile than trial patients (n=51), both cohorts achieved comparable and significant clinical improvements. CONCLUSIONS: In a diverse, high-risk cohort, TTVR dramatically reduced HFH and significantly improved quality of life. These results reinforce the therapeutic benefits of TTVR in high-risk patients with severe TR.